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Organization
APOSTOLIC CHRISTIAN HOME OF ROANOKE ILLINOIS INC.
Active
Organization
APOSTOLIC CHRISTIAN HOME OF ROANOKE ILLINOIS INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD D ISAIA (ADMINISTRATOR)
(309) 923-2071
Entity
Organization
Contact information
Practice address
1102 W RANDOLPH ST, ROANOKE, IL 61561-7528
(309) 923-2071
(309) 923-7919
Mailing address
PO BOX 530, ROANOKE, IL 61561-0530
(309) 923-2071
(309) 923-7919
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0021493
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0021493
—
IL
Enumeration date
09/02/2016
Last updated
01/24/2017
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